A Thin Line

 A friend of mine who's a social worker shared with me a statement from her boss that had made a particularly large impression on her at the time. This supervisor's advice to my friend and the other clinicians on her staff went as follows: "Always remember: the things our clients say about us are true." 

This paradoxical assertion was not meant to be taken literally. After all, my friend works with people suffering from conditions ranging from paranoid schizophrenia to borderline personality disorder. Many are beset by delusions that far exceed the bounds of consensus reality; and even those who aren't often engage in the psychological process of "splitting," whereby they portray their clinicians in exaggerated terms as either wholly good or wholly evil and treacherous. 

The supervisor's point was that all of these conditions—even if they are defined by their departure from consensus reality—nevertheless impart to those who experience them a heightened awareness of the thoughts and feelings of others. Thus, a borderline personality disorder patient's assertion that, say, "you don't like me," even if it is expressing a demand for unconditional loyalty and affection that is unrealistic for most adult members of society to sustain, may nonetheless be a perfectly accurate statement. 

So too: a person suffering from paranoid delusions who is convinced their mental health care professionals are arrayed in conspiracy against them—while they may be exaggerating the point—could nonetheless be picking up on a real frustration, lack of patience, or even contempt that the clinical staff is actually feeling toward them in that moment. 

One can see this insight displayed fully in one of the classic medical testimonies from the history of mental affliction: Daniel Paul Schreber's Memoirs of My Nervous Illness. Schreber's firsthand account of his paranoid delusions and hallucinations—which was deeply influential in the history of psychoanalysis and the subsequent development of clinical psychology—retains much of its power to astonish us, precisely because of the perspicacity that Schreber maintains in the midst of his madness. 

I turned to Schreber in part because—as I wrote a few posts back (channeling Lifton)—we are living through an era in which the balance is being reset between reasonableness and paranoia, sanity and madness. Not only have conspiracy theories become the dominant form of discourse online, but ours is an age in which sober-minded newspapers print columns wondering whether humanity is on its way to creating a "god-machine" in the form of an AI super-intelligence. 

Much as occurred during the early decades of the nuclear arms race, that is to say, our conventional heuristics of what is reasonable and what is paranoid are breaking down. Terrors that were once confined to the realms of religious myth, allegory, and private delusion—such as the impending end of the world—entered consensus reality through the development of ultimate weapons of unprecedented power. Could something similar be happening now with AI? 

And if such is indeed potentially the case, then perhaps the classic works of reason will fail us in confronting our new reality. And if that is the case in turn, perhaps we have something to learn from the classics in the literature of madness. 

If this was the rationale that led me to Schreber's memoir, I can't say I found in it much guidance for living in the age of AI per se. But the book does indeed underline the point that the hard lines we like to draw between sanity and madness are really just heuristics, and that the people living on the other side of the collapse of reason are far closer to us than we would like to admit. We read Schreber and discover that he is us; we are him. 

Schreber's book is full of passages, that is to say, in which we see just how thin the line often is that separates consensus reality from the ravings of a paranoid madman. We see this in Schreber's religious views, for example, in which he invents an elaborate cosmology depicting God as a network of purified nerves. Bizarre, right? And yet: is this exercise meaningfully different from countless works of metaphysical speculation and apologetics that we accept as legitimate intellectual projects?

The thin line appears again when we come to Schreber's conspiratorial political views. When the patient in a mental asylum writes at length about how the Germans are "God's chosen people," and warns of a conspiracy on the part of Eastern European races to "Slavify" Germany, we can comfort ourselves that these are the futile maunderings of a madman. Yet everything in these statements would become the official policy and ideology of the German state, with all-too-notorious results, just a few decades later. 

So too, we see the thin line when Schreber comes to describe the circumstances of his daily life. The patient's clear-eyed and lucid style—his ability to write with perfect clarity about the legality of his confinement, for example; his full familiarity with the literature of hallucination—coupled with his total inability to see his own delusions for what they are—is a large part of what gives the book its eerie power, as well as the unintentional dark humor that impressed Freud. 

Schreber is fully capable of expounding at length how other mental patients' hallucinations are false, for instance; he just insists that his visions are unique in partaking of the nature of genuine supernatural revelation. So too, Schreber is well aware of how his paranoid conspiracism seems to other people; yet he remains tragically convinced that a sufficiently patient exposition of its tenets, such as he attempts in this book, will manage to persuade the sophisticated reader of its truth. 

But most of all in Schreber, we see how little really separates sanity from madness when he describes his treatment at the hands of medical professionals. On the one hand: Schreber incorporates the psychiatrists he encounters into an elaborate paranoid fantasy: Dr. Flechsig, who oversees his treatment at the first asylum he inhabits—is cast in a disembodied role as a malevolent spirit bent on "soul-murder," who has warped the relations prevailing in God's realm such as to bring about a cosmological crisis, which only Schreber can resolve. So too, the orderlies and attendants in the facility are "fleeting-improvised men" (Macalpine and Hunter trans. throughout) rather than human beings. 

As wild and unintentionally comic as these passages may sound, they nonetheless have a foundation in reality and in Schreber's actual clinical experience—exactly as my social worker friend's supervisor described. Schreber traces the beginning of his distrust of Flechsig and his conviction that the later is hiding something from him, for instance, to the "white lies" the latter tells him about the progress of his treatment. After Schreber has spent several more months in confinement and asks Flechsig for an honest prognosis of his chances, the latter prevaricates and refuses to give him a straight answer: 

"I once asked him during a personal visit," Schreber relates, "whether he really honestly believed that I could be cured, and he held out certain hopes, but could not longer—at least so it seemed to me—look me straight in the eye." (emphasis in original.) Here, it seems to us, Schreber is no longer simply being paranoid. It is all too plausible that a medical professional, as a mere mortal, could lose patience and despair of a treatment, and then lose courage when confronted by a patient demanding an honest prognosis, and politely avoid the truth. Flechsig really was hiding something from him—it just wasn't what Schreber's delusions held it to be. 

Likewise, Schreber's conspiracy theories against the orderlies seem to have their foundation in fact. When he accuses the asylum staff of a plot to "unman" him through giving him female sexual organs in order to eventually perpetrate a sexual attack, he roots his fears in what seem to be an all-too-believable set of personal humiliations. One can well see how these episodes would be particularly galling to an older man who had enjoyed an esteemed public career as a judge prior to his confinement: he recounts the vulgar jokes made at his expense while he is forced to take a bath, for example, the way in which a napkin was tied around his neck at meal-times "as if [he] were a little child," the fact that he wasn't allowed to put his feet out of his window at nighttime.

The reason why Schreber wanted to leave his feet in the cold rain was connected with one of his more elaborate hallucinatory delusions. But when he makes his defense of why he ought to be able to do this regardless, he doesn't invoke any supernatural explanations, but merely his right as a human being to make his own personal choices. Indeed, here he sounds perfectly reasonable to me: "What could possibly have happened to me other than contracting a cold? The iron bars gave sufficient protection against the danger of falling out of the window [.... O]ne might well have waited to see whether human beings' natural need for warmth would not have prevented me from keeping the windows open too long." 

In short, beneath the monstrous and deluded forms that Schreber's paranoia takes, there is something perfectly sensible: the legitimate demand of a grown person to be allowed to make his own decisions. What he is suffering above all in the asylum is the loss of the autonomy and dignity he had come to expect as an esteemed jurist in public life. What he senses in the people around him—their contempt, their impatience, their indifference to his fate—no doubt has a great deal of foundation in reality. 

In short, as my friend's supervisor told her: "the things our clients think about us are true." The things Schreber thought about Flechsig and the whole psychiatric establishment were true, in the non-literal sense of the term my friend's supervisor intended. 

And so we see here underlined with especial keenness the same quality that makes Schreber's testimony so ageless and unsettling: Schreber, for all his wildness of speculation, is actually still grappling with the same world we inhabit. We come to the literature of madness expecting to see the difference between its worldview and that of consensus reality; and yet all we seem to find, in its pages, is ourselves staring back.